Provider Demographics
NPI:1083424857
Name:GALE PRIMARY CARE, LLC
Entity type:Organization
Organization Name:GALE PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:228-641-1674
Mailing Address - Street 1:3702 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563-6218
Mailing Address - Country:US
Mailing Address - Phone:228-641-1674
Mailing Address - Fax:228-205-4593
Practice Address - Street 1:3702 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-6218
Practice Address - Country:US
Practice Address - Phone:228-641-1674
Practice Address - Fax:228-205-4593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care